热射病早期临床特征和死亡高危因素的真实世界研究

摘要/Abstract

摘要： 目的分析热射病患者疾病早期诊疗数据,明确病情预警指标和死亡高危因素,优化热射病临床管理策略。方法开展真实世界研究,收集西安市一家区域中心医院急诊科及重症医学科2017年1月1日—2023年12月31日收治热射病患者的临床资料,分析存活组和死亡组疾病早期临床特征的差异,logistic回归分析热射病不良预后的高危因素,并借助受试者工作特征曲线评估其预测效能,采集病例入室血样分选获得血浆,luminex试剂盒检测炎症因子和促炎因子含量。结果共纳入85例热射病患者,其中劳力型热射病53例（62.35%）,经典型热射病32例（37.65%）,主要集中在7—8月（90.58%）,发病90 d病死率为28.23%。死亡组患者近期胃肠道感染率、乳酸、凝血酶原时间（prothrombin time,PT）、部分活化凝血酶原时间（activated partial prothrombin time,APTT）、降钙素原（procalcitonin,PCT）、天冬氨酸转氨酶（aspartate aminotransferase,AST）、丙氨酸转氨酶（alanine aminotransferase,ALT）、尿素氮（blood urea nitrogen,BUN）和肌酐较存活组显著增高（均P<0.05）。Logistic回归分析提示,近期胃肠道感染、高乳酸、BUN和PCT是热射病不良预后的独立危险因素;发病前合并胃肠道感染显著增加热射病患者的死亡风险（OR=7.184,95%CI：1.023~50.460,P<0.05）。发病前合并胃肠道感染患者疾病早期血浆中炎症因子（TNF-α、IL-1ra和IL-6）、趋化因子（CCL2、CXCL8、CXCL10和GM-CSF）和肝肾损伤标志物含量较胃肠功能正常组显著升高（均P<0.05）。结论疾病早期患者血浆中高乳酸、PCT和BUN是热射病死亡的高危因素,三者联合检测效能高;发病前合并肠道感染的患者,疾病早期血浆中炎症因子升高致肝肾损伤,显著增加死亡风险。本研究指导临床医生疾病早期快速识别热射病危重症患者,有助于改善预后。

关键词: 热射病, 临床特征, 高危因素, 肠道感染, 真实世界研究

Abstract: Objective To analyze the early diagnosis and treatment data of patients with heat stroke,clarify the early warning indicators and high risk factors of death,and optimize the clinical management strategy of heat stroke. Methods A real-world study was conducted to collect the clinical data of patients with heat stroke admitted to the emergency department and intensive care unit of a regional central hospital from January 1,2017 to December 31,2023. The differences in early clinical characteristics between the survival group and the death group were analyzed. Multivariate logistic regression analysis was used to identify the high risk factors for the poor prognosis of heat stroke,and the receiver operating characteristic curve was used to verify its predictive efficacy. Blood samples were collected from some patients when they entered the room to obtain plasma,and the luminex kit was used to detect the content of inflammatory factors and pro-inflammatory factors. Results A total of 85 patients with heat stroke were enrolled in this study,including 53 cases(62.35%) of exertional heat stroke and 32 cases(37.65%) of classical heat stroke,mainly concentrated in July and August(90.58%),and the 90-day mortality rate was 28.23%. The recent gastrointestinal infection rate,lactic acid,prothrombin time(PT),activated partial prothrombin time(APTT),procalcitonin(PCT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood urea nitrogen(BUN) and creatinine in the death group were significantly higher than those in the survival group(all P<0.05). Multivariate logistic regression analysis showed that recent gastrointestinal infection,high lactic acid,BUN and PCT were independent risk factors for poor prognosis in patients with heat stroke. Pre-onset gastrointestinal infection increased the risk of death in patients with heat stroke(OR=7.184,95%CI：1.023-50.460,P<0.05). Plasma levels of inflammatory factors(TNF-α,IL-1ra and IL-6),chemokines(CCL2,CXCL8,CXCL10 and GM-CSF) and liver and kidney injury markers were significantly higher in patients with pre-onset gastrointestinal infection than in those with normal gastrointestinal function(all P<0.05). Conclusion High levels of plasma lactic acid,PCT and BUN in patients with early disease are high risk factors for death of heat stroke,and the combined detection of the three has high efficiency. In patients with intestinal infection before onset,elevated plasma inflammatory factors in the early stage of the disease lead to liver and kidney inflammatory injury,which significantly increases the risk of death. This study can guide clinicians to quickly identify patients with severe heat stroke in the early stage of the disease,which is helpful to improve the prognosis.

Key words: Heat stroke, Clinical characteristics, High risk factors, Intestinal infections, Real world study

中图分类号:

R181.3

薛万腾, 吕志慧, 王坤, 王侨欧, 张松涛, 刘善收. 热射病早期临床特征和死亡高危因素的真实世界研究. [J]职业与健康, 2025, 41(20): 2817-2821.

XUE Wanteng, LYU Zhihui, WANG Kun, WANG Qiaoou, ZHANG Songtao, LIU Shanshou. Real-world study of early clinical features and high-risk factors for death in heat stroke. [J]OCCUPATION AND HEALTH, 2025, 41(20): 2817-2821.

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